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ENTITLEMENT PROGRAMS POLICIES, ANALYSIS, AND RESOURCES

The Entitlement Programs Domain tracks and reports on administration efforts to reform Entitlement Programs like Medicare, Medicaid, and Social Security. This domain tracks policies emanating from Congress. Our Principal Analyst is Ann Furbush, who can be reached at ann@usresistnews.org.

Latest Entitlement Programs Posts

 

Work Requirements for Medicaid

The Centers for Medicare and Medicaid Services (CMS) issued a letter on January 11th allowing states to impose work requirements for Medicaid eligibility. Eight states, (AR, AZ, IN, KS, ME, NH, UT, and WI) have pending requests for work requirements as a condition for Medicaid eligibility and CMS has already approved Kentucky’s…

read more

Medicaid Explained

Medicaid is America’s joint federal-state national health insurance program that covers low-income citizens of all ages. Any families or pregnant women with incomes below 138% of the federal poverty line are considered low-income and are eligible for the Medicaid entitlement program. Other eligible beneficiaries include…

read more

The Budget: Medicaid and Food Stamps

Trump’s budget proposal that was released on Tuesday, May 23 follows through with the AHCA bill’s $800 billion in cut to Medicaid over the next decade. As anticipated from the budget draft, this reduction would lead to 23 million fewer Americans insured. Along with work requirements for Medicaid eligibility, the administration…

read more

Medicaid and Planned Parenthood in Texas

In 2011, Texas stopped receiving federal funding because it refused to comply with the federal law requiring states to fund any willing provider. The main reason for this refusal was Planned Parenthood’s involvement in the Medicaid waiver program. Texas instead opted to forgo about $30 million a year in federal funding and…

read more

Medicaid in the Revised AHCA

Despite Donald Trump’s promise in his candidacy announcement speech to not cut Medicaid, the health care bill that passed the House on Thursday includes massive cuts to Medicaid. Although the bill went through the House before a CBO report was produced to assess the amendments, the report released in March estimated…

read more

Medicaid in Florida

President Donald Trump’s Administration is negotiating an agreement with the State of Florida to reinstate federal funding for the low-income pool to $1.5 billion annually. This pool helps reimburse hospitals for the costs accumulated by low-income, uninsured patients. The funds go to covering the hospital costs of emergency…

read more

Work Requirements for Medicaid

After the failure of Trump’s American Health Care Act, some conservative Republicans are calling for work requirements for Medicaid Beneficiaries. The Kaiser Family Foundation update says least four states including Arizona, Indiana, Kentucky, and Pennsylvania have formally submitted waiver requests to require work as a…

read more

Effects of the Budget on Entitlement Programs

President Donald Trump released an outline of his budget proposal, America First, on Thursday, March 16 that substantially boosts spending on homeland security and defense while slashing spending in almost every other area. An important exception to this harsh slashing is entitlement programs such as Medicare…

read more

Medicaid in the American Health Care Act

The proposed American Health Care Act (AHCA) that Republicans released on Monday would restructure Medicaid spending at the Federal and State levels by capping federal funding to the states. Each state would have to come up with any necessary funds beyond this fixed amount. The proposed bill freezes the expansion…

read more

Work Requirements for Medicaid

Letter issued on January 11, 2018

Note: This brief updates previous entitlement programs briefs. For more information, please see the April 12, 2017 brief on work requirements for Medicaid.

Summary

The Centers for Medicare and Medicaid Services (CMS) issued a letter on January 11th allowing states to impose work requirements for Medicaid eligibility. Eight states, (AR, AZ, IN, KS, ME, NH, UT, and WI) have pending requests for work requirements as a condition for Medicaid eligibility and CMS has already approved Kentucky’s weaver. Previous administrations did not approve work requirements for Medicaid because the guidelines do not align with the program’s purpose of promoting health care coverage. The letter asserts that the new policy assists “states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement.” LEARN MORE 

Analysis

Six in 10 nonelderly adults that receive Medicaid benefits are already working. Most of the remaining recipients are not working due to illness, disability, school, or caregiving responsibility, leaving only 7% of nonelderly, Medicaid eligible adults subject to work requirements. Even so, all recipients would have to verify that they are working, looking for a job, or training for employment. States would need to pay for the staff and administrative processes to enforce work requirements. Some eligible recipients may lose coverage due to miscommunication or paperwork errors. In many states, working at minimum wage to adhere to Medicaid work requirements would cause recipients to lose Medicaid eligibility because they would earn too much to qualify.  LEARN MORE 

Engagement Resources

  • Contact Your State Officials – Voice your opinion on the matter to the people who make these important decisions!
  • Families USA – Learn more about Medicaid and how it affects families. Families USA supports the expansion of Medicaid to boost state economies and strengthen the health care system.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact ann@usresistnews.org.


 

Medicaid Explained

Informational Brief

Who Is Eligible

Medicaid is America’s joint federal-state national health insurance program that covers low-income citizens of all ages. Any families or pregnant women with incomes below 138% of the federal poverty line are considered low-income and are eligible for the Medicaid entitlement program. Other eligible beneficiaries include senior and disabled people who receive Supplemental Security Income (SSI). In addition to these mandatory eligibility rules, states can also request federal funds for optional populations such as pregnant women and people with high health-related expenses that have incomes above the mandatory coverage limits.

Where the Money Comes From

The federal government matches state Medicaid spending by a one-to-one ratio or greater. States and the federal government combined spent about $476 billion on Medicaid in 2014. In 2015, Medicaid-related expenses accounted for 57% of state’s federal funds.

Where the Money Goes

Medicaid pays for the services to eligible parties indirectly by paying participating healthcare facilities rather than individual patients. Beyond the minimum federal requirements, each state has the freedom to elect additional services or providers and set their own premiums, provider rates, etc.

Medicaid Effectiveness

Medicaid costs substantially less than private insurance to cover comparable health issues and is found to be cost-effective. Under the Obama Administration’s expansion initiative, Medicaid helped reduce the number of uninsured Americans from 45 million to 29 million as of 2016. Traditionally, Republicans believe the program is too costly and try to cut back on Medicaid spending and eligibility (which is happening right now) while Democrats think it is vital to the overall well-being of American citizens and seek to expand coverage.

Engagement Resources

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact Ann@usresistnews.org.


 

The Budget: Medicaid and Food Stamps

Budget Proposal
Released May 23, 2017

Policy Summary

Trump’s budget proposal that was released on Tuesday, May 23 follows through with the AHCA bill’s $800 billion in cut to Medicaid over the next decade. As anticipated from the budget draft, this reduction would lead to 23 million fewer Americans insured. Along with work requirements for Medicaid eligibility, the administration is also encouraging states to impose stricter work requirements for other anti-poverty programs such as food stamps, or the Supplemental Nutrition Assistance Program (SNAP) and housing assistance. In Georgia, state work requirements for food stamps reduced the number of recipients by more than half. Federal funding for SNAP would decrease by about $190 million over the next ten years according to the new budget. Republicans tend to support this reduction as it saves federal money and encourages people to get to work while Democrats tend to reject it, saying the federal government is leaving the most vulnerable citizens with no safety net for their basic needs. LEARN MORE

Analysis

This proposal is still in its preliminary stages and has a long way to go before anything actually changes. Although lawmakers are likely to alter or dismiss much of it, the proposal provides insight into the priorities of the administration. Those priorities seem to include slashing programs that help the poor such as Medicaid and Food Stamps while giving tax cuts to wealthy Americans. Budget director Mick Mulvaney claims that many of the changes to anti-poverty programs are to encourage recipients to get jobs. However, SNAP already requires able-bodied, childless adults to find jobs within three months and to work at least 20 hours a week. About 44% of the 42 million people who receive SNAP benefits already have at least one family member working. The problem may not be that recipients are not working, but rather that they are not earning enough at their jobs. LEARN MORE

Engagement Resources

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact Ann@usresistnews.org.


 

Medicaid and Planned Parenthood in Texas

Federal Funding Application
Draft Released on May 12, 2017

Policy Summary

In 2011, Texas stopped receiving federal funding because it refused to comply with the federal law requiring states to fund any willing provider. The main reason for this refusal was Planned Parenthood’s involvement in the Medicaid waiver program. Texas instead opted to forgo about $30 million a year in federal funding and in 2013 created its own healthcare for women known as Healthy Texas Women. Now that Trump is President, Texas is looking to restore federal funding for family planning while continuing to exclude Planned Parenthood and any other providers that support abortions. LEARN MORE

Analysis

If the Department of Health and Human Services (HHS) approves Texas’s Medicaid waiver, other conservative states will likely adopt similar strategies to defund pro-abortion providers or undermine Medicaid under Obamacare. For 17 million women, Planned Parenthood is a primary source of essential healthcare as well as reproductive and general health education. If the grant were approved, providers like Planned Parenthood would not be able to see Medicaid patients and those women would have fewer choices for healthcare providers. The Healthy Texas Women program also requires that teenagers have parental approval before accessing any type of family planning services, a provision that could increase unplanned teen pregnancies and STDs. LEARN MORE

Engagement Resources

  • Planned Parenthood – Learn about Planned Parenthood’s services and donate or get involved to keep women in control of their bodies
  • Learn more about Healthy Texas Women and how it has affected women’s reproductive healthcare in Texas.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact Ann@usresistnews.org.


 

Medicaid in the Revised AHCA

Proposed Legislation
Passed House on May 4, 2017

Policy Summary

Despite Donald Trump’s promise in his candidacy announcement speech to not cut Medicaid, the health care bill that passed the House on Thursday includes massive cuts to Medicaid. Although the bill went through the House before a CBO report was produced to assess the amendments, the report released in March estimated Trump’s original plan would cut Medicaid spending by $880 billion over 10 years. The new bill rolls back Medicaid expansion starting in 2019 by cutting federal funding to states. It will also convert Medicaid from an entitlement program, in which the government pays for those who qualify, into a grant program, in which the government gives states either a set amount of money per enrollee or a fixed block grant. These changes will likely leave 14 million fewer people covered by Medicaid after 10 years. LEARN MORE

Analysis

Although the repeal and replace bill still has a ways to go before becoming law, passing the House is a key step that could be devastating for millions of Americans. Health care coverage would depend on where you live under the new bill, as funding would be granted to the states. Because so many people will lose their coverage, $38 billion of federal funds will be added to high-risk pools and maternity and childbirth care. The Bill was pushed through before a CBO report was released so it is unclear how block grants would affect the budget and number of people covered. However, the original CBO report estimated 24 million fewer Americans would have health insurance after 10 years. LEARN MORE

Engagement Resources

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact Ann@usresistnews.org.


 

Medicaid in Florida

Deal Between the Trump Administration and the State of Florida
In Progress

Policy Summary

President Donald Trump’s Administration is negotiating an agreement with the State of Florida to reinstate federal funding for the low-income pool to $1.5 billion annually. This pool helps reimburse hospitals for the costs accumulated by low-income, uninsured patients. The funds go to covering the hospital costs of emergency room visits for uninsured people, providing medical charity care, hospitals absorbing bad debt, and hospitals making up any additional differences between the costs incurred and the payments made. It is a temporary strategy and does not provide healthcare coverage. During the Obama administration, the pool was reduced to about $608 million. The Obama administration withheld these federal funds to encourage states to expand Medicaid under the Affordable Care Act. If the deal goes through and Florida receives federal funding for low-income pools, it is expected to cut state Medicaid spending by roughly $650 million. LEARN MORE

Analysis

Despite the 75% of Americans that think the President and his administration should do what they can to make the ACA work, this deal with Florida sabotages the ACA’s key tool in encouraging states to expand Medicaid. The agreement would essentially subsidize Florida for not expanding Medicaid and encourage other states to do the same or roll back expansion. Other states such as Kansas, Tennessee, and Texas could be a future target for this type of deal as they have also resisted Medicaid expansion and have low-income pools. The Obama administration defunded the low-income pools to encourage people to get insured under the ACA. Now, uninsured people have federal funding for their care through these low-income pools and have less incentive to get insurance. After his own failed healthcare act, Trump said the best thing to do is “let Obamacare explode.” Deals like the one in Florida undermine the ACA and facilitate a healthcare failure. LEARN MORE

Engagement Resources

  • Contact Your State Officials – Voice your opinion on the matter to the people who make these important decisions! Learn more about what some GOP Governors are doing to keep Medicaid expansion and get in touch with them.
  • Kaiser Family Foundation Tracking Poll – Learn more about the future direction of the ACA, Medicaid, and healthcare in America and see how Americans feel about these changes.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact Ann@usresistnews.org.


 

Work Requirements for Medicaid

Proposed State Legislation
Ongoing

Policy Summary

After the failure of Trump’s American Health Care Act, some conservative Republicans are calling for work requirements for Medicaid Beneficiaries. The Kaiser Family Foundation update says least four states including Arizona, Indiana, Kentucky, and Pennsylvania have formally submitted waiver requests to require work as a condition for Medicaid eligibility. Each state’s proposal differs slightly but none have been approved. Florida, which is currently one of the toughest states to get Medicaid coverage, is eying new work requirements as well. Indiana, Montana, and New Hampshire offer voluntary work program referrals to adults covered by Medicaid, and some states are considering follow those models. LEARN MORE

Analysis

Supporters, like health and human services chairman Rep. Travis Cummings, argue that the requirements are “an effort to encourage people to work and take their health care more seriously” and that Medicaid is eating up too much of the budget. Others argue that requirements could increase program costs if individuals are denied coverage and then need emergency care. If the work requirements were implemented, monitoring and enforcing them would be difficult and costly. Overall, the impact of Medicaid work requirements is not expected to be very large as the majority of Medicaid recipients who are able to work already do. LEARN MORE

Engagement Resources

  • Contact Your State Officials – Voice your opinion on the matter to the people who make these important decisions!
  • Families USA – Learn more about Medicaid and how it affects families. Families USA supports the expansion of Medicaid to boost state economies and strengthen the health care system.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact ann@usresistnews.org.


 

Effects of the Budget on Entitlement Programs

Budget Proposal – America First: A budget Blueprint to Make America Great Again
Proposal released March 16, 2017

Policy Summary

President Donald Trump released an outline of his budget proposal, America First, on Thursday, March 16 that substantially boosts spending on homeland security and defense while slashing spending in almost every other area. An important exception to this harsh slashing is entitlement programs such as Medicare, Medicaid, and Social Security. Although Health and Human Services spending decreases 16%, this cut comes from slashing health care programs outside of entitlement. America First instead proposes investing in Health Care Fraud and Abuse Control (HCFAC) in Medicaid, which has proven to payoff a five to one ROI. LEARN MORE

Analysis

Entitlement Programs got very little attention in the proposed budget. A more comprehensive budget is expected for May of this year, which may include changes to entitlement programs. The Trump Administration could be waiting for the American Health Care Act to gain momentum before proposing any major budgetary changes in Medicaid, although so far the bill has proven to be unpopular even among Republicans. The budget proposal was not expected to include any major changes to entitlement programs as much of these issues are instead addressed in the proposed American Health Care Act. Cuts in these programs are expected to come later. LEARN MORE

Engagement Resources

  • AARP – AAPR opposes the Health Care Bill and continues to fight to keep social security strong. This link to the Advocacy section of the AARP website provides a platform for people to learn how social security and health care reform affect them as well as an option to join AARP.
  • Save My Care – This website is dedicated to fighting for full health care coverage. It provides opportunities to sign up for updates and events as well as stories of people who have benefited from the Affordable Care Act.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact ann@usresistnews.org.


 

Medicaid in the American Health Care Act

Proposed Legislation
Replacement Bill released March 6, 2017

Summary

The proposed American Health Care Act (AHCA) that Republicans released on Monday would restructure Medicaid spending at the Federal and State levels by capping federal funding to the states. Each state would have to come up with any necessary funds beyond this fixed amount. The proposed bill freezes the expansion of Medicaid from the Affordable Care Act effective January 1st of 2020. This proposed freeze caused some discrepancies among Republican Senators as at least 4 Republican Senators say they will not vote for a bill that fails to protect Americans who became eligible for coverage under the ACA’s expansion of Medicaid. On Thursday, March 9th the bill passed the House Ways and Means Committee, a permanent committee of the House that recommends bills that will raise government revenue. LEARN MORE

Analysis

Obamacare expanded Medicaid to over 11 million people in 31 states as it broadened the coverage standards. The new bill’s freezing of this expansion may mean millions will now go uninsured. In 2010 Arizona froze enrollment in KidsCare, the Children’s Health Insurance Program (CHIP) under Medicare. This freeze led to savings of $12.9 million in FY 2011, but it has also resulted in over 100,000 children being placed on a waiting list for coverage. The AHCA’s freeze will likely do the same; save the government money but cover less people. Other concerns regarding the bill are the AHCA’s ability to effectively respond to unforeseen circumstances such as recessions, disease outbreaks, or the release of a new, expensive drug. In these situations, without additional funding, states would have to ration coverage. LEARN MORE

Engagement Resources

  • American Medical Association – AMA is strongly opposing the ACA replacement bill. On their website, you can learn about efforts to stop health insurance merger, see their vision for health care reform, and read articles about their AHCA opposition and why.
  • National Committee to Preserve Social Security and Medicare – This independent group fights to boost social security, prevent cuts to Medicaid and Medicare, and protect the working class. The website offers ways to show support, become an advocate, and join their forces.
  • American Public Health Association – The APHA supports public health in many areas, including policy and advocacy. The website also provides a fact sheet about why we still need the ACA. On the website you can donate, become a member, and sign up for their newsletter.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact ann@usresistnews.org.


 

Repeal and Replace Obamacare: Effects on Medicaid

Proposed Legislation
Plan outline released on February 16, 2017

Policy Summary

Republicans released a replacement plan outline for the Affordable Care Act that they claim will increase coverage while decreasing prices, but it’s unclear how. In Health Care, there are no perfect answers and are always tradeoffs. Many believe Obamacare “sacrificed affordability in order to get more people insured” by expanding expensive Medicaid programs to reach over 70 million additional Americans. The proposed legislation would transition Medicaid from an entitlement program with guaranteed federal funding, to a per capita allotment or a block grant per program. LEARN MORE

Analysis

Republicans claim these changes will give states the flexibility and control they need while Democrats argue the number of people covered and the quality of care will decline. Proposed legislation “empowers states to design plans that will best meet their needs and put Medicaid on sustainable financial footing.”  Many are worried that states would not be able to react quickly enough to natural disasters, terrorist attacks, disease outbreaks, or other emergencies that require Medicaid’s assistance. The new plan is also criticized for its proposal to fix Medicaid spending and then raise it at the annual rate of inflation when “medical costs consistently rise faster than inflation.” LEARN MORE

Engagement Resources

  • Centers for Medicare and Medicaid Services – Official government website that provides information about Medicare and Medicaid as well as opportunities to get involved.
  • Health Leads – An organization dedicated to providing community-based tools for a healthy lifestyle. This website provides opportunities to volunteer or donate to the cause.
  • Families USA – Advocacy group for nation-wide, affordable health care coverage with opportunities to donate, sign a petition, reach out to Congress members, and learn more about Health Care issues and trends.

This brief was compiled by Ann Furbush. If you have comments or want to add the name of your organization to this brief please contact ann@usresistnews.org.


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